Disclose Information on the Receipt of Funds, Medicines and Medical Supplies, Distribution of Medicines, Medical Supplies and Patients Treated on the Website of the Municipality July 2017 (KIG0002)

• Leveraging OGP for a Transparent COVID-19 Response in Africa (November 1, 2020)

Issue to be addressed: Provision of health services in Tanzania is a government responsibility. Kigoma Ujiji Municipal Council mainly depends on central government disbursement of funds to implement its budget for purchase of medical supplies and by small amount from its own source collection. It’s a tendency of central government to release less amount of the approved budget, not in time or not at all for medical supplies. With small amount of financial resources, the capacity to provide services automatically goes down. In so doing, residents of Kigoma do not get satisfying health services offered. Now and then Council’s officials receive complains that they either still funds or medical supplies. Due to this, staff is being discouraged and the relationship between the health workers and patients or public in general is always not good at all. Kigoma Municipality investigated the cause and find out to be disclosed information on the receipt of funds, medical supplies and the distribution of medical supplies to be the source. Also, some of health workers are not trustful. To deal with this, Kigoma Ujiji Municipal Council Commit itself to solve the problem in hand by tracking the all system and disclose the information so that residents may make a close follow up on provision of health services. Primary objective: To manage medical commodities in the Municipal Council by tracking the whole supply chain from Medical Store Department (MSD) to the final consumer and bring about transparency and accountability on health sector Short description: With the use of developed computer Software, the Municipal Council can manage and disclose online information on fund received, medical supplies, distribution of medicines, number of patients treated, the number of deaths, births, what kind of medical supplies to be ordered and when. Accountability and access to information to the public will be enabled OGP challenge: Municipal Council intend to use a computer Software called OKOA developed by local resident of Municipality to manage medical supplies in Council and provides public access to information. This software has four direct users and one indirect user Municipal Council (Direct User) • Access 100+ reports from all Hospitals, Dispensaries and Health Centers on disbursement of medical supplies to each health facility from MSD and its dispensing to patients, intelligence reports on drugs theft, inventory, finances, diseases, deaths, births, expired or due to expire drugs and highly demanded drugs National Medical Store (MSD) & Zonal Stores • Manage its in-house drugs inventory, disbursement to each hospital, Health Center, dispensary and access inventory reports from any health facility in the country including expired drugs, out of stock drugs & highly demanded drugs Hospital/Dispensary/Health Center/MSD Pharmacy • Manage drugs inventory, dispensing of those drugs to patients, record diseases, deaths, births in their facility and access 100+ reports including revenue collection, inventory, diseases, deaths, births Ministry Of Health • Access 100+ reports from both MSD and all hospitals, health centers, dispensaries countrywide including inventory & disbursement of drugs at MSD to those health facilities in the country, drugs theft intelligence at those facilities, revenue collection and finances at all facilities, diseases, deaths and birth reports from all those health facilities in the whole country Public (Indirect Users) • Residents can access reports generated and transferred to Municipal website for transparency. Those reports include drugs availability in hospitals, diseases, deaths and birth reports. Reports do not show patients details but only statistics of those diseases so that one can know what is going on and take precautions.

2. Health Services Transparency

Commitment text

Disclose information on the receipt of funds, medicines and medical supplies, distribution of medicines, medical supplies and patients treated on the website of the Municipality July 2017.

The main objective is to manage medical commodities in the Municipal Council by tracking the whole supply chain from Medical Store Department (MSD) to the final consumer and bring about transparency and accountability in health sector.

With the use of developed computer Software, the Municipal Council can manage and disclose online information on funds received, medical supplies, distribution of medicines, number of patients treated, the number of deaths, births, what kind of medical supplies to be ordered and when. Accountability and access to information to the public will be enabled.

Municipal Council intend[s] to use a computer Software called OKOA developed by a local resident of Municipality to manage medical supplies in the Council and provides public access to information.

Milestones

2.1. Publish Receipt of funds for the purchase of medical support and their allocation for public use monthly

2.2. Publish Medical supplies procured for designated hospitals, health centres and dispensaries for public use monthly

2.3. Publish the availability of medication in designated hospitals, health centres and dispensaries for public use monthly

2.4. Publish the number of patients treated in designated hospitals, health centres and dispensaries and the most common diseases treated for public use monthly

2.5. Publish Treatment prices for public use monthly

2.6. Publish Reports of births, deaths and disease outbreaks for public use monthly

2.7. Publish Health sector infrastructure, furniture and staffing levels for public use monthly

Commitment Overview

Commitment aim

Overall Objective & Relevance

Residents in Kigoma Ujiji often face poor access to quality health services and medical supplies, as well corruption in the health sector. Over 94% of the municipal health budget comes from the national government. ^{This is according to the most recent Sub-national (Local Government) PEFA Assessment in Tanzania – Kigoma Ujiji Municipal Council commissioned in 2016 by the Ministry of Finance.} According to the latest Public Expenditure and Financial Accountability (PEFA) Program evaluation from July 2016, Kigoma Ujiji Municipal Government (KUMG)’s overall score on the credibility of the budget sits at D (equivalent to 2 out of 8 – 1 being the lowest score and 8 the highest), largely because of the low predictability in transfers from the national government. ^{PricewaterhouseCoopers, “Sub-national (Local Government) PEFA Assessment in Tanzania”, (October 2016),}

page 9, https://pefa.org/sites/default/files/TZ-Jul16-PFMPR-SN-Final%20Consolidated%20Report_1.pdf. According to the action plan, the lack of sufficient funds and transparency in the way the national government disburses them, affects the quality of services and leads to citizen distrust.

In light of these circumstances, this commitment seeks to fully disclose information on the receipt of funds, medicines and medical supplies, the distribution of medicine, medical supplies and treated patients on the Municipality’s website by July 2017. This will contribute to transparently managing medical commodities in the Municipal Council by tracking the whole supply chain from medical store department (MSD) to the final consumer and bring about transparency and accountability in the health sector. The commitment is broken down into several milestones, specifying which information is to be made public and with what periodicity.

The Municipal Council’s objective was to increase the disclosure of health services data in order for citizens to be fully aware of the state of health services provision. This was to be achieved through an online platform (http://www.okoa.co.tz) that allows citizens and government officials to track in real time the availability of both human resources, as well as essential medical supplies. Citizens would be able to confirm availability of both before visiting a health center. Therefore, the commitment is relevant to the OGP values of access to information and technology and innovation for transparency and accountability.

Specificity and Potential Impact

The IRM researcher considers this commitment to be of high specificity as the milestones include a list of documents and/or information to be made public and specific timelines for delivery. The commitment also clearly indicates the method of publication i.e. through the Council website as well as the online platform http://www.okoa.co.tz.

The fulfillment of the commitment could significantly improve public confidence in health services provision in Kigoma. According to a report by Sikika, an NGO focused on promoting accountability in the health sector, corruption in health is mainly attributed to failure of the existing health governance framework. ^{Sikika (2014) Institutional factors influencing petty corruption in the public health sector in Tanzania. Available at http://sikika.or.tz/wp-content/uploads/2015/05/Petty-Corruption-Study-Booklet-ENGLISH.pdf.} Citizens are unaware of critical information related to health services and even when they obtain access to such information, they often do not use available accountability structures at facilities. Consequently, those working in the health sector find no incentive to deliver the services transparently. On the other hand, in a recent poll titled ‘Health check: A citizen diagnosis of health sector challenge’ Twaweza notes that 70% of Tanzanians who attend public hospitals/health facilities are unable to obtain essential medicines and other medical supplies. ^{http://www.thecitizen.co.tz/News/70pc-lack-drugs-in-hospital--Twaweza/1840340-4077556-3teqyu/index.html.} Among other factors, this is attributed to poor disbursement of funds from the national government, which inhibits the ability of the Council to purchase and deliver essential medicines and supplies. Residents of Kigoma, therefore, often do not receive satisfactory health services. Council’s officials often receive complaints and accusations of embezzlement due to the unavailability of essential medical supplies. This contributes to a loss of public confidence between health workers and patients, thus affecting the quality of services rendered.

The commitment calls upon the publication of the information with the use of an online tool called OKOA. Although this is a major step forward, considering this data is currently unavailable, the disclosure of health-related information using only an online resource is limited in scale. While there are no official statistics for internet penetration in Kigoma Ujiji, in Tanzania broadly, only 11.3% of the population have access to the internet. ^{Internet World Statistics, Tanzania: http://www.internetworldstats.com/africa.htm#tz.} The main means of communication with citizens of Kigoma is not through the internet, but through Street Assemblies, ward meetings and other in-person means. However, because this information has never been made systematically available, this commitment could contribute to a moderate change in access to information, particularly at the health center level.

Completion
Substantial

Overall, this commitment’s implementation has been substantial. Between July and December 2017, the IRM researcher was able to confirm that most of the information had been published (in English and in Kiswahili) on the OKOA platform in accordance with the commitment milestones and in a user-friendly format. For example, the platform allowed users to search for available medicine by medical facility, and view a list of health centers in Kigoma Ujiji by wait time (this information was available only in the Kiswahili version of the platform).

However, at the time of writing this report, the OKOA platform is inactive, and has not been updated since December 2017 (updated twice: in July and August 2017), when the funding initially received to develop the platform ended. Notably, at the time of writing this report, the “Statistics” tab is no longer accessible, despite having been accessible in the Kiswahili version in 2017. ^{The IRM compared the current website (http://www.okoa.co.tz/) with an earlier archived version of the website from December 2017, available at https://web.archive.org/web/20171221045325/http://okoa.co.tz:80/public_statistics.php.} Most of this information has now been migrated to the Council’s website where the Council Management Team has asked the Council’s information officer to update information on a quarterly basis.

The IRM researcher reviewed the available information while visiting the Council’s website (http://www.kigomaujijimc.go.tz/announcements/3). However, information on births and deaths (Milestone 2.6) is currently missing as well as information on the availability of health-related infrastructure (Milestone 2.7). The IRM was able to confirm that information on the price and availability of medicine (Milestone 2.4 ^{http://www.kigomaujijimc.go.tz/announcement/gharama-za-matibabu-kwa-vituo-vya-afya-ndani-ya-manispaa-kigoma-ujiji} ) is now published on the council website as well as funds, medical supplies received (Milestone 2.1 ^{http://www.kigomaujijimc.go.tz/announcement/fedha-za-mradi-wa-afya-mpango-wa-taifa-kudhibiti-magonjwa-yaliyokuwa-hayapewi-kipaumbele-may-2017} ) and the number of patients (Milestone 2.5 ^{http://www.kigomaujijimc.go.tz/announcement/taarifa-ya-wagonjwa-waliotibiwa-july-2016-hadi-machi-2017} ) attended at the various health centers in Kigoma Ujiji. The website, however, does not present any evidence of quarterly updating beyond June 2017 when the last update was published.

Early results: did it open government?
Access to information: Marginal

Prior to the establishment of the OKOA platform, citizens in Kigoma Ujiji did not have the means to track the availability or prices of essential medical supplies at health facilities. The new platform wwww.okoa.co.tz allows citizens to access critical health sector information including the availability of essential medicines, health workers, pricing information, funds receipt, and basic statistics on number of patients attended etc. However, while the OKOA platform is an important initiative in terms of access to health sector information, the infrequency of updates to the platform (not updated since December 2017) limits its practical accessibility. Also, although civil society notes that the software is a major improvement to the status quo, they also point to its limited practical reach, as many citizens are unable to access the web-based platform. However, the Municipal Council has not frequently updated the platform since the original funding received through an MCC/PEPFAR project ended in April 2017. On the other hand, the application has not served to reinforce existing health governance mechanisms through which accountability in the sector ought to be enforced.

Recommendations

OKOA is an important innovation with significant potential to improve access to health sector information. Nonetheless, for OKOA to be effective it is imperative that it contributes to strengthening existing health governance structures and mechanisms. Such structures include the Health Facility Governance Committee, the Street Assembly Social Services committee, the Ward Development Committee and the Council Standing Committee on Health and Education. It is important to target these structures, as they have the incentive to monitor progress in the health sector and enforce accountability.

In order to enhance the impact of the platform, it is also important to provide an offline interface that allows citizens with limited access to internet to also interact with the platform. This could be achieved through the development of an Unstructured Supplementary Service Data (USSD) application through which citizens can access the relevant data.

Lastly, despite the readily availability of information however, there is no dedicated feedback mechanism that would provide citizens with the opportunity to give feedback and influence decision making in relation to the health sector. As such, the Kigoma Ujiji government could establish a new means for reinforcing accountability in the health sector based on the information made available through this commitment.